Cocaine-Induced Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report and Review of the Literature

Vijaya Dasari and Charles D. Donohoe


Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiological phenomenon that occurs due to a disruption in the autoregulation of the cerebral blood flow resulting in vasogenic edema. It is seen most often in settings of acute hypertension and is often associated with eclampsia. Symptoms that PRES patients commonly present with include seizures, visual disturbances, headache, and altered mental status.
Case: We present a patient and review select cases cited in the literature that cocaine, a common drug of abuse, can precipitate hypertension with PRES. Our patient initially presented with severe headache, acute renal failure, hypertension, profound somnolence, and a widespread vasogenic edema after relapsing and using cocaine. Within 24 hours and with control of her blood pressure, her symptoms resolved and she was alert, cognitively intact and free from any identifiable residual effects.
Conclusion: We suggest that this rapid sequence of clinical and neuroimaging abnormalities following cocaine ingestion may not be a rare phenomenon. As has been previously described, the magnitude of PRES related vasogenic edema is not well correlated with either symptom severity or ultimate clinical outcome.

Published on: December 22, 2018
doi: 10.17756/jnpn.2018-025
Citation:  Dasari V, Donohoe CD. 2018. CocaineInduced Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report and Review of the Literature. J Neuroimaging Psychiatry Neurol 3(2): 30-34.